20-287 Stay Current with MCAS Updates to Be Sure You Meet Performance Levels
Date: 03/23/20
This information applies to Physicians, Participating Physician Groups (PPGs).
This information applies to Medi-Cal in Fresno, Kings and Madera counties.
Latest changes released for 2020 measurement year
On July 19, 2019, Health Net*, on behalf of CalViva Health, notified providers about new quality measures known as the Managed Care Accountability Set (MCAS), released by the Department of Health Care Services (DHCS). You can refer to provider update 19-524, Help Your Patients Achieve Better Health Outcomes for more details. DHCS now requires managed care plans and participating providers to meet the national Medicaid 50th percentile minimum performance level (MPL) for each MCAS measure based on the National Committee for Quality Assurance (NCQA) Quality Compass.
New changes for 2020 measurement year
On December 31, 2019, DHCS updated the MCAS list for the 2020 measurement year. New changes to MCAS are outlined in the table on page 2. Providers and plans must still meet the MCAS Measurement Year (MY) 2019/Reporting Year (RY) 2020 requirements as outlined in provider update 19-524.
Timely submissions of claims, encounters and medical records impact your performance rates
We encourage providers to stay up to date with the coding guidelines as outlined in the most recent release of the HEDIS 2020 Volume 2: Technical Specifications. You can purchase the guidelines from the NCQA website at www.ncqa.org.
For more information on coding and best practices, providers can access the Healthcare Effectiveness Data and Information Set (HEDIS®) tip sheets and best practices at www.provider.healthnet.com under Quality > Provider Tip Sheets. Providers can also email the Quality Improvement Department at cqi_dsm@healthnet.com.
Resources for claims and encounters requirements
Participating physician groups (PPGs) and providers are required to report services according to the terms of the Provider Participation Agreement (PPA). Providers can also refer to the Health Net provider operations manuals for more information on billing and reporting requirements, which is available at www.provider.healthnet.com under Provider Library > Operations Manuals > Claims and Provider Reimbursement > Billing and Submission.
Additional information
Providers are encouraged to access the provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CalViva Health at 1-888-893-1569.
Highlights of the 2020 measurement year changes
The complete MCAS list is available online at: www.dhcs.ca.gov/dataandstats/reports/Documents/MMCD_Qual_Rpts/HEDIS_Reports/Managed-Care-Accountability-Set-Reporting-Year-2021.pdf.
Removed | Added | Changed |
Adult Care
- HbA1c testing with outcomes
| Behavioral Health (pediatric and adult)
| Transitional Care
|
Pediatric Care Children and Adolescent Access to Primary Care Practitioners (CAP) | Pediatric Care
|
|